Cerebral Palsy: Causes, Symptoms, and Treatments
Medikoe Health Expert
Koramangala, bengaluru, karnataka, india, Bengaluru Feb 10, 2017
What is Cerebral Palsy?
Cerebral palsy refers to various types of neurological conditions that affect the motor movement, muscle coordination and posture of a person. Besides that, in some cases, the hearing, vision, and sensation are affected too and the patient might have to go through emotional and behavioral challenges. Cerebral Palsy could also bring about changes in the spine and problems in the joints.
This is a condition that is seen as congenitally or during early childhood. This occurs due to abnormal brain development or damage in the developing brain (i.e. before, during, or right after birth)thus having an effect on both voluntary and involuntary movements. This disorder is usually noticed from infancy onwards and seems to persist throughout life.
Cerebral Palsy is an umbrella term for a group of symptoms and disabilities in a person due to neurological damage, therefore it occurs with varying degrees of severity. Some patients have the ability to walk, while others may need assistance. There are cases where patients have cognitive and intellectual disabilities, but in most cases, these abilities are not compromised and the patient might show normal or near-normal intellect. And in a few cases, the patient might have to deal with epilepsy, blindness or deafness.
The symptoms of cerebral palsy do not progress, which means the conditions do not worsen, but the symptoms have reduced or have become more evident over time. Patients with this condition can be expected to have a normal lifespan and also a decent quality of life.
CP is not that rare, and in fact, contributes to being one of the common reasons for having movement disorders. In fact, according to data provided by the CDC, it affects 1,4 to 4 in every 1000 children worldwide.
Causes of Cerebral Palsy
Cerebral palsy occurs when the developing brain is underdeveloped or undergoes damage during development. The damage usually occurs before, during or right after birth, but in rare cases, children seem to have acquired the condition a little later after birth; this could be due to brain damage in the early years, bacterial or viral infections in the brain, etc.
Most common causes of cerebral palsy are:
If the white matter of the fetus’ brain is damaged, usually due to injury during gestation.
Abnormal brain development could occur if the mother has an infection or any disease during pregnancy
During labor and delivery, the child could undergo stress which could lead to a lack of oxygen in the brain
Intracranial hemorrhage i.e bleeding in the brain which could be caused when the baby has a stroke while inside the womb
Jaundice being untreated- In certain cases, a child is born with jaundice, should this condition go untreated it could lead to cerebral palsy
Mutation: During development, the child could undergo gene mutation or it could be hereditary
In rare cases, CP happens because something goes wrong during a child's birth.
If the developing brain undergoes brain damage due to a car accident, child abuse or if the mother takes a fall.
If the mother ingests toxins during her pregnancy
Brain damage in infancy or early childhood can also lead to CP. For example, a baby or toddler might suffer damage from lead poisoning, bacterial meningitis, poor blood flow to the brain, being shaken as an infant (shaken baby syndrome), being in a car accident
General Symptoms of Cerebral Palsy
Since Cerebral Palsy occurs due to the damage in the brain during development, the symptoms appear during infancy or early childhood. Since it affects the motor movements, most of the symptoms deal with abnormal movement in the body, This would include abnormal reflexes, uncontrollable or involuntary movements, lack of muscle coordination, improper posture, stiffness or flaccidity in the muscles, etc. Patients could also have a hard time breathing, swallowing or talking.
Types of Cerebral Palsy and Symptoms
As mentioned above, cerebral palsy is an umbrella term, and thus it varies from people to people. It has been classified based on the movement disorders which helps us determine the area of the brain that has been affected. Namely,
Spasticity: In this case, the muscles have been affected and thus movement is inhibited
Dyskinesia: In this case, the patient has no control over voluntary movements and one can observe uncontrolled movements
Ataxia: In this case, there is poor balance and coordination of the muscles.
There are Four types of Cerebral Palsy
Based on the above classifications-
1. Spastic CP: This is the most commonly occurring form of CP, i.e in 70% of the patients. People with spastic CP mainly have stiff muscles, therefore limiting the movement. Symptoms of spastic CP include:
Delayed development in the movement of body parts
Abnormal body movements.
Limited range of movement
Stiffness in the muscles
Mostly affects the upper and lower limbs, and therefore difficulty when it comes to movement,
Based on the part of the body or the muscles that have been affected spastic CP is further classified into three types:
Spastic hemiplegia: In this case, muscle stiffness only occurs at one side that is the left or right side. It may be limited to a few body parts like an arm, a hand or just a leg or all three at the same time. Therefore, only one side of the body will have hindered development. The intelligence of the patient is rarely affected but he or she may have occasional seizures.
Spastic diplegia: In this case, the lower part of the body is affected, i.e the lower limbs, while the upper body does not show any signs of muscle inhibition. Patients with spastic diplegia have their legs crossed at the knees, also known as scissoring. Patients with this type of disorder can walk provided that they have some assistive devices like walkers or wheelchairs.
Spastic quadriplegia: In this case, the muscles all over the body are affected. In such cases, the cognitive ability of the patient is compromised. Patients with this condition have a hard time doing simple activities like walking and movement of their limbs.
2. Ataxic Cerebral Palsy: In this case, the cerebellum of the brain is injured and therefore, the patient has poor muscle coordination. Due to this, the muscles are overly relaxed, making the arms and legs appear floppy.
The appearance of the patients with this condition is compared to that of a rag doll. The intelligence and cognitive abilities of patients with ataxic CP are not affected. In fact, some of them have good communication skills, but in some cases, patients show signs of cluttering. This is the least common type of CP.
Improper muscle coordination
Having no control over the movement of the head, which could be dangerous for children.
Delayed development of motor functions when compared to others of the same age
Experiencing difficulty in breathing.
Looseness in the ligaments and joints giving the patient a floppy appearance
Poor depth perception and improper body balance
Impaired mobility and difficulty in walking, usually have an unsteady gait
Unable to stand or sit without proper assistance.
Difficulty with movements that require precision like writing, tying shoelaces or buttoning the shirt.
Tremors, and shaky movements that are difficult to control.
3. Dyskinetic Cerebral Palsy: In this case, the patient has very less control over the movement of the muscles. A person with dyskinetic CP has changing muscle tones, i.e it switches between too tight to too loose on the same day or might change on a day-to-day basis.
The symptoms include,
Dystonia; repetitive twisting motions.
Athetosis, writhing movements i.e, arms and legs move uncontrollably or may show jerky movements.
Too much activity on the muscles all over the body, including the face and mouth, means the children have a tendency to drool as well as difficulty in swallowing or talking.
Trouble hearing, breathing, and also with muscle coordination near the mouth.
Intelligence and cognitive abilities are rarely compromised.
4. Mixed Cerebral Palsy: In these cases, as the name suggests, patients have symptoms for two or more of the above-mentioned types. Most of the time, it is a mix of spastic CP and dyskinetic CP. For example, a child may have stiff muscles in some parts of the body like in spastic CP and then jerky movements in other parts of the body like in dyskinetic CP.
Diagnosis of Cerebral Palsy
Since CP is a disorder found in children, it is imperative that it is diagnosed at an early stage as this can help improve the care provided to the patient. Most children are diagnosed during their first two years.
CP does not have a particular test that helps its detection. Doctors may have to run various screening tests that help us understand the muscle development and motor skills of the child.
Children will have to pay regular visits where the doctor conducts various tests to observe the child’s reflex, muscle tone and coordination, posture, growth, hearing and vision, and control over motor movements.
Doctors may also take use neuroimaging techniques like Magnetic resonance imaging (MRIs), cranial ultrasounds, electroencephalogram (EEG’ s), and Computed tomography(CT) scans to study the child’s brain which would help determine if the disorder is treatable.
Treatment of Cerebral Palsy
Cerebral Palsy does not have a proper cure but with different treatments and therapies, it can help decrease the symptoms and improve the lifestyle of the patient. Children diagnosed with CP will have a team of health professionals such as a pediatrician, speech therapist, physiotherapist, and a psychologist to help with the various symptoms. With time, the treatments will be reviewed and revised based on the results and improvement shown.
Besides medication, children can undergo a variety of therapies. This includes physical therapy for the muscles, occupational therapists to help with movements and later on wheelchair assessments which would further help the child gain independence, speech therapists to help with speech and communication as well as to help with issues pertaining to eating and swallowing, and recreational therapy to help improve the child's motor skills and emotional well-being.
Children may also have to undergo surgical procedures to help with muscle tightness or help repair bone anomalies.
The patients can also use assistive devices to compensate for the various symptoms regarding communication skills and motor movement. This could include computers, voice synthesizers, braces, wheelchairs, walkers, etc.
Doctors can devise a treatment plan using one of the above treatments or a combination of all of the above methods. There have been many cases where the children have gone on to lead an almost normal adult life due to proper care and treatment given at the early stages. This is exactly why it would be ideal for the diagnosis and treatment to be done as early as possible so that there can be some development or progress in the patient’s lifestyle.
Prevention of Cerebral Palsy
Cerebral Palsy occurs due to various causes. There is no perfect way to prevent it. But if proper care is taken before and during pregnancy and also given to the child, then it will reduce the chances of the child having the condition.
Precautions that can be taken by the mother before and during her pregnancy:
Before conceiving the mother should check for various medical conditions, and ensure the treatment of these conditions.
During her pregnancy, she has to avoid taking drugs, smoking, consuming alcohol.
Avoid being in toxic environments or undertaking too much stress. Should the mother be going through too much stress, it would be wise to meet with a counsellor and get the required health.
The mother should also get vaccinated for various diseases before conception, as sometimes getting diseases during pregnancy would affect fetal development.
Precautions to be taken after the baby is born and during its growth:
Once the baby is born, check for signs of jaundice, and treat it immediately.
Take necessary precautions to avoid the child from contracting meningitis or encephalitis.
As the child is growing, raise home in a protected environment, where the risks of brain injury or damages are low. Baby-proof the house.
Avoid physically abusing the child, or violently shaking the child.
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